Articles > Health Insurance Articles > HMO vs. PPO
Health insurance coverage is a definite need for everybody. With rising medical care costs, health insurance can help you pay for doctor consultations, lab tests, hospital stays and surgeries, and any other medical care you may need.
Health insurance plans can basically be divided into two categories: traditional plans, and managed care plans. Traditional indemnity plans, also known as fee-for-service plans, were the most common type of plans till a couple of decades ago. In these plans, individuals paid a certain amount of medical expenses up front in the form of a deductible, and afterwards, the insurance company paid the majority of the bill.
Increasing costs of providing medical care caused insurance companies to look for ways to remain profitable, and this led to the promotion of managed care, which is the most popular form of health insurance today. Managed care plans involve an arrangement between the insurer, and a selected network of health care providers, in which policyholders are offered significant financial benefits for using the services of the network.
Managed care plans are of three types: Preferred Provider Organization (PPO) plans, Point-of-Service (POS) plans, and Health Maintenance Organization (HMO) plans. PPOs give policyholders a financial incentive to stay within their network of health care providers. With a PPO, you can refer to a specialist in the network without getting approval, and have less paperwork and less money going out of your pocket. You can choose to go out of the network, but that will involve more paperwork, higher payments, and even some deductibles. POS plans are similar to PPO health insurance, except that they have a Primary Care Physician (PCP), who acts as the gatekeeper. If you need to refer to a specialist, or to an out-of-network doctor, you must go through your PCP.
With HMO insurance, instead of paying for each individual service that you receive, you pay a fixed monthly or quarterly premium. In return, you are offered a range of health benefits, but only within its network of provider, doctors, specialists, and labs. To visit a specialist in the network, you must go through your primary care physician.
PPO insurance provides better flexibility, in that you can make self-referrals, and visit any doctor you want, including those outside the PPO network, without a referral from a PCP. HMO's are more affordable, but provide less flexibility.
You can search for affordable health insurance plans on the Internet. There are several websites where you can get information on health insurance online, and request for online health insurance quotes from a variety of companies. After comparing a few health insurance quotes, and checking each one’s costs and benefits, you can select a low cost health insurance plan that will provide adequate coverage for affordable premiums.
Finding a cost-effective health insurance plan can be tricky, but is possible with a little bit of research and consultation. With the knowledge that you don’t have to shoulder all the costs of any medical care needs for yourself and your family, health insurance can give you peace of mind to focus on getting better and living a healthier life.
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